A nurse is reviewing the diagnostic test results of a female client who is about to undergo knee arthroplasty. Which of the following data collection findings should the nurse identify as the priority?
Creatinine 0.9 mg/dL
WBC count 20,000/mm3
Potassium 3.8 mEq/L
Hematocrit 40%
The Correct Answer is B
a. Creatinine 0.9 mg/dL: This creatinine level is within the normal range and is not an immediate priority for knee arthroplasty.
b. WBC count 20,000/mm3: An elevated white blood cell count suggests the presence of
infection or inflammation. In the context of knee arthroplasty, infection is a significant concern and requires immediate attention to prevent complications.
c. Potassium 3.8 mEq/L: This potassium level is within the normal range and is not an immediate priority for knee arthroplasty.
d. Hematocrit 40%: This hematocrit level is within the normal range and is not an immediate priority for knee arthroplasty. The elevated WBC count takes precedence as it suggests a
potential infectious process.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
a. Apply a warm cloth over the client's eyes: This intervention is not typically indicated for a client who had a craniotomy. It is important to monitor for signs of increased intracranial pressure, but a warm cloth over the eyes is not a standard intervention.
b. Place the client in a supine position: The position of the client after a craniotomy will depend on the surgeon's preference. It is important to follow specific postoperative positioning
instructions, which may or may not include supine positioning.
c. Maintain seizure precautions: Seizure precautions are crucial for clients who have had a craniotomy, as they are at an increased risk of seizures postoperatively.
d. Obtain a prescription for an opioid medication for pain: Pain management is important, but opioid medications may be carefully titrated due to the potential for respiratory depression and other side effects. It is not the primary intervention in the immediate postoperative period.
Correct Answer is D
Explanation
a. Pleural friction rub: Pleural friction rub is a grating sound heard during inspiration and
expiration and is associated with inflammation of the pleura. It is not typically associated with asthma exacerbation.
b. Fine rales: Fine rales (crackles) are usually heard during inspiration and can be associated with conditions such as pneumonia or pulmonary fibrosis. They are not the typical lung sounds in
asthma exacerbation.
c. Rhonchi: Rhonchi are low-pitched wheezes heard during inspiration and expiration. While they can be associated with asthma, expiratory wheezes are more specific to asthma
exacerbation.
d. Expiratory wheeze: Expiratory wheezes are high-pitched, musical sounds heard during
expiration and are characteristic of asthma exacerbation. They result from narrowed airways and increased airway resistance.
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